Hearings suggest Supreme Court is split on what to do about the Accountable Care Act

Hearings suggest Supreme Court is split on what to do about the Accountable Care Act

AHA NewsApr 2, 2012

The Supreme Court wrapped up three days of hearings on the “Patient Protection and Affordable Care Act” (ACA) last Wednesday, with the justices appearing divided over whether all, some or none of the health care law should stand if the individual mandate, a critical part of the law that would require Americans to purchase insurance, is struck down.

Wednesday’s sessions were devoted to the questions of whether the law can survive without the individual mandate; and whether the law coerces states to expand Medicaid. And if the law is coercive, does it matter legally?

The government argued that only two provisions of the law – a prohibition against insurers discriminating against people with preexisting conditions and a limitation on how insurers set rates – depend on the mandate. The rest of the law should stand.

Justices Antonin Scalia, Anthony Kennedy and Samuel Alito appeared to agree with the plaintiffs that the whole law should fall if the mandate falls, and expressed concerns for the losses insurers would suffer if the two provisions remained in place. Chief Justice John Roberts pointed out that much of the ACA is totally unrelated to the mandate, but also expressed con­cerns about the economic consequences of leaving only part of the law in place. Justice Stephen Breyer questioned how the Court should decide which provisions stay and which fall, and floated the idea of a remand to the lower courts to work it out.

On the Medicaid question, some justices, including Kennedy, expressed concern whether states actually have a choice to accept the new Medicaid funding, while others appeared to reject the coercion argument on the facts and the law.

The individual mandate.

Wednesday’s legal doubleheader came a day after the court’s conservative justices questioned the constitutionality of the individual mandate. The sessions began on Monday, with the court hearing arguments on whether the 1867 “Anti-Injunction Act” prevents the justices from ruling on the health care law before its individual mandate takes effect in 2014.

The 26 states and others challengingthe law argue that the individual mandate is unconstitutional and should be struck down because it requires most Americans to purchase health insurance or pay a fee to the Internal Revenue Service if they don’t.

Based on questions posed by the court, Breyer, Kagan, Bader Ginsburg and Sotomayor seemed to favor upholding the mandate.

Scalia and Alito appeared deeply skeptical of the mandate. Justice Clarence Thomas did not question either side, as is his practice during oral arguments.

Roberts and Kennedy joined in vigorous questioning of both the governments’ and plaintiffs’ attorneys. Kennedy called the mandate “unique” and Roberts suggested that everyone is already participating in the health care market. Kennedy seemed to suggest that a mandate directed at individuals could be upheld only if the government offered an extremely powerful justification.

In defending the mandate, Solicitor General Donald Verrilli argued that it would not open the door to other requirements to buy productsbecause health care is unique. He said that if a person elected not to get health insurance, but then got sick – as nearly everyone will at some point – that person would pass along costs to everyone else.

To prevent that, Congress can use its authority under the commerce clause of the Constitution to impose the mandate as a way to regulate health insurance.